Cancer Prevention Program

PACE [Promoting Activity and Changes in Eating] Project

Reducing Obesity at the Workplace: A Randomized Trial

P.I. Shirley Beresford, PhD

The PACE Project is a group-randomized controlled intervention trial to maintain or decrease body mass index at the worksite level. The project developed a comprehensive multi-level intervention that provided simple strategies related to moderating dietary intake and increasing energy expenditure for individuals to follow to achieve a balance. The intervention was informed by Social Learning theory, and designed to change structural and environmental cues and to provide behavioral change strategies to individual employees through tip sheets and a self-help manual to improve self-efficacy, skills and social norms around healthy eating and physical activity. Gradual changes in social norms were expected such that behavior change is maintained long-term. Participating companies are in King, Pierce and Snohomish counties.

Of the 34 companies participating, 17 were randomly selected for the immediate PACE Project intervention group and 17 were assigned to the comparison group, that received a delayed PACE Project intervention. The intervention companies establish an Employee Advisory Board [EAB] that made all the decisions as to how the intervention initiatives were to be implemented at their company. The PACE study provided all developed materials for the study. Each EAB member was provided with an Employee Advisory Board Handbook and a DVD containing all printed materials used for the project. The idea of constant inescapable messages was a theme throughout the intervention and had been used in previous worksites studies. The intervention itself consists of a protocol specifying the minimum activities required to occur in each worksite. The eighteen-month intervention followed a timeline that outlined five distinct phases (1) fostering awareness of physical activity and healthy eating, (2) providing motivation and support for increasing physical activity behavior, (3) providing motivation and support to improve dietary intake, (4) establishing a support system to encourage increased physical activity and healthy eating intake, and (5) supporting the maintenance of physical activity and dietary behavior.  Each EAB had the autonomy to tailor the suggested activities outlined in their handbook or to develop activities specific to their worksite environment which met the goals of the specific phase. Intervention companies were provided with a link to the PACE website.

The evaluation compared the effectiveness of the intervention in reduce or maintain body mass index in a randomized trial of worksites from baseline and two-year follow-up, using serial cross-sectional surveys. The employees randomized to the intervention group had similar eating habits, average fast food meals per month and servings of fruit and vegetables per day to comparison worksite employees at baseline. From the company questionnaire, about 50% worksites were classified as manufacturing, transportation, communications, wholesale or trade companies. About 30% companies had a workforce with about 30% blue collar jobs. The average size was 130 employees. Targeting the worksite environment was one of the goals, and, based on the Checklist of Health Promotion Environments at Worksites, significant differential improvements were found in the informational environment related to both nutrition and physical activity at two year follow-up.

Beresford SAA, Locke E, Bishop S, West B, McGregor B, Bruemmer B, Duncan G, Thompson B. Worksite Study Promoting Activity and Changes in Eating (PACE): Design and Baseline Results, Obesity 2007 (Nov); 4S-15S.

Beresford SAA, Bishop SK, Brunner NL, Duncan GE, McGregor BA, McLerran DF, West B, Thompson B. “Environmental assessment at worksites after a multilevel intervention to promote activity and changes in eating: the PACE project.” J Occup Environ Med. 2010; 52 Suppl 1:S22-S28. PMC3261837

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